胸部CT对结缔组织病相关性肺动脉高压的诊断价值  

Diagnostic Value of Chest CT in Connective Tissue Disease Associated Pulmonary Hypertension

作　　者：许万阳 王磊[1] XU Wanyang;WANG Lei(Department of Respiratory Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院呼吸内科,河南郑州450052

出　　处：《河南医学研究》2022年第12期2240-2244,共5页Henan Medical Research

摘　　要：目的探讨胸部CT对结缔组织病相关性肺动脉高压(CTD-PAH)的诊断价值。方法选取2018年3月至2021年12月郑州大学第一附属医院经超声心动图诊断的119例CTD-PAH患者,纳入PAH组。根据肺动脉收缩压(PASP)高低将119例患者分为轻度组(56例)、中度组(26例)和重度组(37例)。选取76例PASP正常的系统性红斑狼疮(SLE)、混合性CTD(MTCD)、系统性硬化(SSc)患者,纳入对照组。收集患者基础资料以及血常规、炎症指标、ANA滴度等常规实验室指标。对患者行胸部CT平扫检查,测量肺动脉直径(dPA)、主动脉直径(dA)及计算dPA与dA的比值(rPA)。探讨dPA、rPA对CTD-PAH的诊断意义。结果两组PASP、dPA、rPA、N末端B型利钠肽前体(NT-proBNP)比较,差异有统计学意义(P<0.05)。rPA升高、dPA增大、NT-proBNP>300 ng·L^(-1)是CTD患者合并PAH的高危因素(P<0.05)。对照组、轻度组、中度组和重度组rPA、dPA比较,差异有统计学意义(P<0.05)。与对照组比较,轻度组、中度组、重度组rPA值均较高,dPA较大(P<0.05)。轻度组、中度组、重度组rPA值组间比较,差异无统计学意义(P>0.05)。重度组dPA大于轻度组(P<0.05)。受试者工作特征(ROC)曲线分析显示,rPA>1.0诊断CTD-PAH的敏感度、特异度分别为85%、75%,dPA>32.4 mm诊断CTD-PAH的灵敏度及特异度分别是74%、90%。结论rPA升高、dPA增大、NT-proBNP>300 ng·L^(-1)是CTD患者合并PAH的高危因素。rPA>1.0、dPA>32.4 mm对CTD患者合并PAH具有诊断意义。Objective To explore the diagnostic value of chest CT in connective tissue disease associated pulmonary hypertension(CTD-PAH).Methods A total of 119 patients with CTD-PAH diagnosed by echocardiography in the First Affiliated Hospital of Zhengzhou University from March 2018 to December 2021 were selected and included in PAH group.According to pulmonary arterial systolic pressure,119 patients were divided into mild group(56 cases),moderate group(26 cases)and severe group(37 cases).A total of 76 patients with systemic lupus erthematosus(SLE),mixed CTD(MTCD)and systemic sclerosis(SSc)with normal PASP were selected and included in control group.The basic data of patients and routine laboratory indexes such as blood routine,inflammation index and ANA titer were collected.The patients were examined by plain chest CT.The diameter of pulmonary artery(dPA),the diameter of aorta(dA)and the ratio of dPA to dA(rPA)were measured.The diagnostic significance of dPA and rPA in CTD-PAH was explored.Results There were statistical differences in PASP,dPA,rPA and N-terminal pro-B-type natriuretic peptide(NT-proBNP)between the two groups(P<0.05).Elevated rPA,increased dPA and NT-proBNP>300 ng·L^(-1) were the high risk factors of PAH in CTD patients(P<0.05).Compared with rPA and dPA of control group,mild group,moderate group and severe group,the difference was statistically significant(P<0.05).Compared with control group,the rPA values of mild group,moderate group and severe group were all higher,and dPA were larger(P<0.05).There was no statistical difference in rPA among mild group,moderate group and severe group(P>0.05).dPA in severe group was higher than that in mild group(P<0.05).The analysis of receiver operating characteristic(ROC)curve showed that the sensitivity and specificity of rPA>1.0 in diagnosing CTD-PAH were 85% and 75% respectively,and that of DPA>32.4 mm in diagnosing CTD-PAH were 74% and 90% respectively.Conclusion The high rPA,dPA and NT-proBNP>300 ng·L^(-1) are the high risk factors of PAH in CTD patients.rPA>1.0

关 键 词：结缔组织病 肺动脉高压 肺动脉直径与主动脉直径比值 

分 类 号：R593.2[医药卫生—内科学]